Camposclemensen1749
Neurosurgical spine specialists receive considerable amounts of industry support that may impact the cost of care. The aim of this study was to evaluate the association between industry payments received by spine surgeons and the total hospital and operating room (OR) costs of an anterior cervical discectomy and fusion (ACDF) procedure among Medicare beneficiaries.
All ACDF cases were identified among the Medicare carrier files from January 1, 2013, to December 31, 2014, and matched to the Medicare inpatient baseline file. The total hospital and OR charges were obtained for these cases. Charges were converted to cost using year-specific cost-to-charge ratios. Surgeons were identified among the Open Payments database, which is used to quantify industry support. Analyses were performed to examine the association between industry payments received and ACDF costs.
Matching resulting in the inclusion of 2209 ACDF claims from 2013-2014. In 2013 and 2014, the mean total cost for an ACDF was $21,798 and $21,008, respectively; mean OR cost was $5878 and $6064, respectively. Mann-Whitney U test demonstrated no significant differences in the mean total or OR cost for an ACDF based on quartile of general industry payment received (P= 0.21 and P= 0.54), and linear regression found no association between industry general payments, research support, or investments on the total hospital cost (P= 0.41, P= 0.13, and P= 0.25, respectively), or OR cost for an ACDF (P= 0.35, P= 0.24, and P= 0.40, respectively).
This study suggests that spine surgeons performing ACDF surgeries may receive industry support without impacting the cost of care.
This study suggests that spine surgeons performing ACDF surgeries may receive industry support without impacting the cost of care.
Chiari malformation type I (CMI) cases are frequently associated with basilar invagination (BI), which complicates the understanding of the pathology of CMI. We specifically evaluated the morphometric and volumetric alterations in the bony structures of CMI patients without BI.
Fifty adult CMI patients without BI treated at our institution from January 2015 to December 2019 were retrospectively studied. The morphometric and volumetric characteristics of the posterior cranial fossa (PCF) were analyzed using thin-slice computed tomography images.
Compared with the controls, the clivus length (P < 0.001), supraoccipital length (P < 0.001), Klaus height index (P < 0.001), axial length (P < 0.001), clivo-axial angle (P < 0.001), tentorial angle (P < 0.05), and bony PCF volume (P < 0.001) of the CMI-only group were significantly smaller, and the distance between the Chamberlain line and the dens axis (P < 0.001), clivus angle (P < 0.001), and basal angle (P < 0.001) of the CMI-only group were significantly larger, while the distance between the McRae line and the dens axis, McRae line, anteroposterior diameter of the PCF, occipital angle, occipital canal angle, and tentorial Twining line angle showed no significant difference between the 2 groups.
Hypoplasia of the clivus and occipital bone were confirmed in CMI patients without BI, thus providing further evidence for the notion that CMI is secondary to the underdevelopment of the PCF.
Hypoplasia of the clivus and occipital bone were confirmed in CMI patients without BI, thus providing further evidence for the notion that CMI is secondary to the underdevelopment of the PCF.
Acute bilateral vocal fold paralysis is a life-threatening complication that can occur during spinal surgery but has almost exclusively occurred with anterior approaches. Bilateral vocal fold paralysis after posterior spinal surgery has been exceedingly rare.
We present a case of acute postoperative dyspnea due to vocal fold paralysis requiring intubation and surgical intervention after posterior spinal correction for the treatment of dropped head syndrome. The patient had had a previous diagnosis of atypical Parkinson disease but was later diagnosed with multiple system atrophy.
We suggest that multiple system atrophy can result in an increased risk of bilateral vocal fold paralysis during surgical intervention of dropped head syndrome. Thus, our report could be of interest for those who perform spinal surgery in patients with neurological conditions.
We suggest that multiple system atrophy can result in an increased risk of bilateral vocal fold paralysis during surgical intervention of dropped head syndrome. Thus, our report could be of interest for those who perform spinal surgery in patients with neurological conditions.
Resection of deep medial frontal and parietal arteriovenous malformations (AVMs) is often challenging due to a tangential angle of attack and deep, narrow working corridor. Adequate visualization of the AVM and its feeding arteries without brain retraction is of particular importance when operating in or near eloquent cortical areas, where brain manipulation could inadvertently result in neurologic deficits. The aim of this paper is to provide a step-by-step description of surgical approach and report our experience with the contralateral transfalcine approach for resection of deep-seated parasagittal AVMs.
Contralateral transfalcine resection of deep frontal, parietal, and cingulate gyrus AVMs was performed with the unaffected hemisphere positioned in a gravity-dependent manner in 5 cases. Surgical procedures were video documented, and an illustrative case is presented. All 5 patients had a modified Rankin Scale score of 0 or 1 at the last follow-up.
Complete resection of the AVM was achieved in all 5 cases. No permanent major neurologic deficit was observed postoperatively. This approach allowed a superior visualization of arterial feeders, the parenchymal side of the AVM, and an early control of small parenchymal feeders while minimizing retraction of the brain.
The contralateral transfalcine approach is a useful technique in the cerebrovascular surgeon's armamentarium for management of deep-seated medial frontal, parietal, and cingulate gyrus AVMs in or around eloquent brain areas, allowing to minimize normal brain retraction and avoid associated neurologic deficits.
The contralateral transfalcine approach is a useful technique in the cerebrovascular surgeon's armamentarium for management of deep-seated medial frontal, parietal, and cingulate gyrus AVMs in or around eloquent brain areas, allowing to minimize normal brain retraction and avoid associated neurologic deficits.
Cervical arthroplasty has established itself as a safe and efficacious alternative to fusion in management of symptomatic cervical degenerative disease. Recent literature has indicated a trend toward decreased risk of reoperation with cervical arthroplasty, and reoperation in this subset commonly occurs secondary to recurrent pain and device-related complications. The instance of cervical arthroplasty migration, particularly in the setting of trauma, is particularly rare. Here, we report the first case of implant migration secondary to iatrogenic trauma following neck manipulation during direct laryngoscopy for mechanical intubation.
A 53-year-old smoker with cervical spondylosis underwent a cervical 3/4 arthroplasty with a ProDisc-C implant. About a month postoperatively, he was intubated via direct laryngoscopy for community acquired pneumonia and began experiencing new dysphonia and dysphagia after extubation. Delayed imaging revealed anterior migration of the implant. The patient immediately underwentled to migration of the implant. We recommend the integration of fiberoptic technique or video laryngoscopy with manual in line stabilization for intubation of post cervical arthroplasty patients when airway management is necessary within 10 months after cervical arthroplasty. Clinicians and anesthesiologists should have a high clinical suspicion for prompt and early workup with spine imaging in the setting of persistent postintubation symptoms such as dysphonia and/or dysphagia.
The popularity of the ventriculoatrial shunt as a means for cerebrospinal fluid diversion was temporally limited, overcome by the success of the peritoneum as a site for distal drainage. click here Nevertheless, it remains an important tool for patients for whom ventriculoperitoneal shunting is not an option.
We present the case of a 9-year-old girl with a ventriculoatrial shunt, who had undergone multiple revisions. Ultimately, she suffered a wound dehiscence, resulting in infectious seeding of the bloodstream and formation of a thrombus, presumed granuloma, at the tip of the distal catheter in the right atrium. She underwent successful removal of the lesion via an open approach by our cardiothoracic colleagues.
Previous authors have noted a high number of mortalities as a result of these lesions. A collaborative approach resulted in a successful outcome for our patient. Although limited in utility today, the ventriculoatrial shunt remains a common procedure for neurosurgeons today.
Recognizing the potential for atrial thrombus formation and using a team approach can help avoid a poor outcome.
Recognizing the potential for atrial thrombus formation and using a team approach can help avoid a poor outcome.
Frameless stereotactic biopsy represents a minimally invasive procedure used for the histopathological diagnosis of brain tumors or to safely approach deep-seated lesions near eloquent areas not amenable for classical neurosurgical procedures. Traditionally, biopsy is performed relying on anatomical landmarks, but it can lead itself to intra- and postoperative complications, such as hemorrhage and fiber disruption. Diffusion tensor imaging (DTI) tractography represents a useful tool that can analyze the individual fiber tract conformation in cases of brain tumor and consequently identify the best biopsy trajectory, preserving white matter pathways. In our study, we present a novel technique that is based on the use of preoperative DTI for biopsy.
Between January 2018 and January 2020, data about patients who underwent frameless biopsy using DTI tractography were retrospectively reviewed. The inclusion criterion was adult patients eligible for elective surgery for a single or multiple deep-seated lesions with contraindications to complete surgical resection.
We included 12 patients (mean age of 67.9 [±9.6] years). A single cranial lesion was detected in 7 cases, and multiple lesions in 5 cases. The use of DTI enabled the identification of white matter pathways in all cases and adjustment of the biopsy trajectory based on anatomical landmarks in 7 cases. Postoperative hematoma was reported in 1 case, and histological diagnosis was obtained in 11 cases.
According to our results, tractography is a useful tool that can enhance the safety of cerebral lesions biopsy sparing any fiber tract damages.
According to our results, tractography is a useful tool that can enhance the safety of cerebral lesions biopsy sparing any fiber tract damages.
Spinal epidural arteriovenous fistulas (SEAVFs) are rare lesions with a low risk of hemorrhage. Most patients with lumbosacral SEAVFs with hemorrhagic events will develop a spinal epidural hematoma from epidural venous pouches. To the best of our knowledge, we have reported the first case of a lumbosacral SEAVF presenting with remote intramedullary hemorrhage in the conus medullaris.
A 56-year-old man presented with sudden-onset severe paraparesis and bowel/bladder dysfunction. Magnetic resonance imaging of the thoracic and lumbosacral spine showed acute intramedullary hemorrhage in the conus medullaris surrounded by spinal cord congestion extending to T8, with perimedullary flow voids along the ventral and dorsal cord surfaces. Magnetic resonance angiography and spinal angiography confirmed the presence of a SEAVF with a large lumbosacral epidural venous lake supplied by dorsal somatic branches of bilateral L4 segmental arteries. Initially, the intradural venous drainage had been misinterpreted as a single route.
